Provider Demographics
NPI:1144476078
Name:MISQUITTA, PRATIBHA MELWYN (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PRATIBHA
Middle Name:MELWYN
Last Name:MISQUITTA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N GERMANTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6215
Mailing Address - Country:US
Mailing Address - Phone:901-752-5996
Mailing Address - Fax:901-751-9799
Practice Address - Street 1:955 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6215
Practice Address - Country:US
Practice Address - Phone:901-752-5996
Practice Address - Fax:901-751-9799
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist